John Harlan Kitterman IV, MS, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

2675 Palo Verde Blvd S
Lake Havasu City, AZ 86403-4919

Phone

(626) 484-9759

NPI assigned

Jun 29, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1164109302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3735 TOTEM DR",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864067959",
            "telephone_number": "626-484-9759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 PALO VERDE BLVD S",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864034919",
            "telephone_number": "626-484-9759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KITTERMAN",
        "first_name": "JOHN",
        "middle_name": "HARLAN",
        "name_suffix": "IV",
        "credential": "MS, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-29",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Athletic Trainer in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.